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S3-Leitlinie: Hormonersatztherapie und Krebsrisiko

S3 guideline: Hormone replacement therapy and cancer risk

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Der Gynäkologe Aims and scope

Zusammenfassung

Die Hormonersatztherapie (HRT) bei peri- und postmenopausalen Frauen ist die effektivste Behandlung klimakterischer Beschwerden und gehört zu den am häufigsten eingesetzten endokrinen Therapien. Bei der Verordnung sind Nutzen und Risiken gegeneinander abzuwägen. Zu den potenziellen Risiken gehört das erhöhte Krebsrisiko. Risikomodifikationen betreffen überwiegend das Mamma-, das Endometrium- und das Ovarialkarzinom. Eine HRT kann das Brustkrebsrisiko erhöhen, abhängig von der Zusammensetzung der eingesetzten Präparate und der Anwendungsdauer. Eine HRT mit Östrogenen und Gestagenen (EPT) erhöht das Risiko stärker als eine Östrogenmonotherapie (ET). Bei einer EPT sind Anwendungszeiten von ca. 5 Jahren erforderlich, um eine geringe Risikosteigerung nachzuweisen. Bei der ET ist die Risikosteigerung erst nach längeren Anwendungszeiten nachweisbar. Eine ET kann bei postmenopausalen Frauen zu einem erhöhten Endometriumkarzinomrisiko führen. Daher soll bei nichthysterektomierten Frauen grundsätzlich nur eine EPT mit ausreichend langer Gestagenanwendung erfolgen. Eine Anwendungszeit einer EPT bis zu 5 Jahren erhöht das Endometriumkarzinomrisiko nicht. Längerfristige sequenzielle Therapien können zu einer Erhöhung des Endometriumkarzinomrisikos führen. Für die mehr als fünfjährige kontinuierlich kombinierte EPT sind die Studienergebnisse diesbezüglich kontrovers. Der Zusammenhang zwischen einer HRT und dem Ovarialkarzinomrisiko wurde in der Vergangenheit kontrovers beurteilt. Eine jüngere Metaanalyse zeigt, dass eine HRT (ET bzw. EPT) das Risiko erhöhen kann. Aufgrund der geringen Inzidenz des Ovarialkarzinoms ist das absolute Risiko relativ gering. Die differenzierte Aufklärung der Patientin über o. a. Risiken ist vor Anwendung einer HRT zur Behandlung klimakterischer Beschwerden zu beachten. Sie ist in die Entscheidungsfindung miteinzubeziehen und bei der Durchführung einer HRT zu berücksichtigen.

Abstract

Hormone replacement therapy (HRT) is the most efficient treatment for climacteric symptoms and is one of the most frequently prescribed endocrine therapies. Before prescription of any form of HRT, the associated risks and benefits should be weighed up against each other. Potential risks include breast, endometrial, and ovarian cancer. HRT may increase the risk of breast cancer, depending on the duration of treatment and the specific HRT preparation. Combined HRT with estrogens and progestins (EPT) is associated with a higher risk of breast cancer than estrogen-only preparations (ET). Specifically, EPT increases the risk of breast cancer after around 5 years of treatment, whereas ET shows this effect only after longer treatment durations. ET may increase the endometrial cancer risk in postmenopausal women. Non-hysterectomized women should therefore only be treated with EPT of sufficient dosage and duration. Application of EPT for up to 5 years does not increase the endometrial cancer risk. Long-term sequential EPT regimens may increase the endometrial cancer risk. Study results on the use of continually combined EPT for over 5 years are controversial. The association between HRT and ovarian cancer risk is uncertain. However, a recent meta-analysis demonstrated that HRT (ET and EPT) may increase the ovarian cancer risk. Due to the low incidence of this disease, the absolute risk is low. Before the use of any form of HRT, women should be appropriately informed about the abovenamed risks and benefits of this treatment for climacteric symptoms. These risks have to be included in the decision for or against HRT, and have to be reconsidered during the course of long-term use of HRT.

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Authors and Affiliations

  1. Klinik für Frauenheilkunde und Geburtshilfe, Caritas-Krankenhaus St. Josef, Universität Regensburg, Landshuter Str. 65, 93053, Regensburg, Deutschland

    Olaf Ortmann

  2. Klinik für Gynäkologie und Geburtshilfe, Georg-August-Universität Göttingen, Göttingen, Deutschland

    Günter Emons

  3. Klinik für Frauenheilkunde, Marien Hospital Herne – Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland

    Clemens Tempfer

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  1. Olaf Ortmann
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  2. Günter Emons
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Correspondence to Olaf Ortmann.

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O. Ortmann, G. Emons und C. Tempfer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Ortmann, O., Emons, G. & Tempfer, C. S3-Leitlinie: Hormonersatztherapie und Krebsrisiko. Gynäkologe 53, 29–34 (2020). https://doi.org/10.1007/s00129-019-04504-2

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